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Aladawi M, Elfil M, Najdawi ZR, Ghaith H, Sayles H, Thorell W, Hawkes MA. Aneurysmal Subdural Hematoma: A Systematic Review. Neurocrit Care 2024; 41:244-254. [PMID: 38332336 DOI: 10.1007/s12028-024-01938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Aneurysmal subdural hematoma (aSDH) is a rare complication of aneurysm rupture, affecting between 0.5 and 7.9% of patients with aneurysmal subarachnoid hemorrhage (aSAH). The clinical presentation, course, and outcomes of these patients are largely unknown. OBJECTIVE This study aims to systematically review the literature to evaluate the demographics, clinical presentation, aneurysm location, treatment options, and outcomes of patients with aSDH with and without aSAH. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review of three databases (PubMed, EMBASE, and Google Scholar). From identified reports, we extracted data on patients' demographics, clinical presentation, imaging findings, surgical interventions, and clinical outcomes. We compared clinical outcomes, need for surgical treatment, and aneurysm location between patients with aSDH with and without concurrent aSAH using χ2 and Fisher's exact tests. We used simple and multivariable logistic regression models to further examine the association between the presence of aSAH and surgical treatment with clinical outcomes. RESULTS We identified 112 articles with a total of 270 patients (70% women, mean age 52.8 [± 15.5] years). The most common aneurysm locations were the middle cerebral artery, followed by the posterior communicating artery, and the internal carotid artery. Patients with isolated aSDH fully recovered more frequently than those with concomitant aSAH (38% vs. 6%). The presence of aSAH increased the odds of unfavorable outcome (odds ratio [OR] 2.68, 95% confidence interval [CI] 1.34-5.37). Surgical treatment was inversely associated with unfavorable outcome in the univariable (OR 0.48, 95% CI 0.28-0.84) but not in the multivariable analysis (OR 0.76, 95% CI 0.35-1.66). CONCLUSION aSDH occurs infrequently. Simultaneous presence of both aSDH and aSAH from an aneurysmal source is associated with poor outcomes. Surgical treatment is associated with lower rates of unfavorable outcomes including death and severe disability.
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Affiliation(s)
- Mohammad Aladawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zaid R Najdawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hazem Ghaith
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Harlan Sayles
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - William Thorell
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Maximiliano A Hawkes
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Neurology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA.
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Liu J, McHugh F, Li Y. Spinal subdural haemorrhage secondary to strenuous exercise and warfarin, complicated by acute ischaemic stroke. BMJ Case Rep 2024; 17:e258729. [PMID: 38442981 PMCID: PMC10916092 DOI: 10.1136/bcr-2023-258729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Spinal subdural haemorrhage or haematoma (SSDH) is a rare condition that is often overlooked and missed on initial presentation due to its non-specific features that may mimic other more common pathologies. It is associated with high morbidity and mortality rates, with few evidence-based management principles, particularly during the subacute stages of recovery. In this report, we detail a case of SSDH associated with exercise and anticoagulation therapy, which was complicated by acute ischaemic stroke. SSDH should be suspected in cases of acute back pain without a clear alternative cause, particularly in coagulopathic individuals. Following treatment, early recommencement of anticoagulation therapy may be justified in certain cases where indicated, after careful consideration of the affected individual's risk profile.
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Affiliation(s)
- James Liu
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Frances McHugh
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Yingda Li
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney School of Medicine, Sydney, New South Wales, Australia
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Hashiguchi A, Tashima K, Tonegawa T, Moroki K, Tokuda H. Subarachnoid Hemorrhage From Ruptured Aneurysms at the Internal Carotid Artery-Posterior Communicating Artery Bifurcation Not Detectable on Preoperative Imaging Studies. Cureus 2024; 16:e53691. [PMID: 38455832 PMCID: PMC10918616 DOI: 10.7759/cureus.53691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Since subarachnoid hemorrhage (SAH) due to the re-rupture of cerebral aneurysms severely worsens the prognosis, an accurate initial diagnosis is essential. Computed tomography (CT) and magnetic resonance imaging (MRI) usually detect aneurysmal subarachnoid hemorrhage (aSAH). However, in rare cases, its identification on CT- and MRI scans is difficult, and a cerebrospinal fluid (CSF) examination is required. We present preoperative imaging and intraoperative findings in patients whose aSAH detection necessitated a CSF examination. Of 225 aSAH patients who underwent preoperative imaging studies at our institution between April 2010 and August 2019, 3 females (1.3%, mean age 57.3 years) harbored undetectable aSAH due to the rupture of an internal carotid artery-posterior communicating artery (ICA-PcomA) aneurysm. The aneurysmal orientation was inferolateral. Intraoperatively, the anterior petroclinoid ligament hampered the detection of the aneurysms that firmly adhered to the surrounding arachnoid membrane. Sustained arterial pulsation and successive minor hemorrhage can lead to the gradual adhesion of an ICA-PcomA aneurysm to the surrounding arachnoid membrane and explain their atypical rupture undetectable on imaging studies and the development of acute subdural hematoma without SAH.
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Affiliation(s)
| | - Kozo Tashima
- Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN
| | - Takeshi Tonegawa
- Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN
| | - Koichi Moroki
- Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN
| | - Hajime Tokuda
- Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN
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Bastiana DS, Sani AF, Ardhi MS, Kurniawan D, Suharto AP. Acute subdural hematoma during sexual intercourse due to an aneurysm rupture on posterior communicating artery: a case report. Radiol Case Rep 2023; 18:1316-1319. [PMID: 36698719 PMCID: PMC9868230 DOI: 10.1016/j.radcr.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Patients with an acute subdural hematoma (aSDH) usually have a history of head trauma, but some patients may present with spontaneous aSDH due to a ruptured aneurysm. Spontaneous aSDH is a rare manifestation of aneurysmal rupture. However, aneurysmal rupture remains a major cause of spontaneous aSDH. A 42-year-old man was brought to the emergency room because of a sudden loss of consciousness during sexual intercourse. The patient has seizures and weakness on the right side of his body. The patient has no history of trauma and has never taken anticoagulant or antiplatelet drugs, sexual aphrodisiacs, or other drugs. Physical examination revealed the Glasgow Coma Scale of E2V1M3, ptosis on the left eye, left pupil mydriasis, right central facial palsy, and right hemiparesis. Laboratory results showed hypercoagulopathy. Noncontrast head computed tomography scan revealed subdural hematoma with no subarachnoid or intraparenchymal hemorrhage. The patient underwent an emergency craniotomy, and the hematoma was evacuated. Cerebral angiography was performed 1 week later, revealing a saccular aneurysm in the left posterior communicating artery. The patient has successfully undergone endovascular coiling and was discharged from the hospital in good condition, fully conscious, with no weakness in half side of the body, but there is still third nerve palsy. Patients with pure aSDH without a history of trauma should consider the possibility of aneurysm rupture and perform an angiographic examination to rule out vascular malformations so that the patient can receive appropriate treatment.
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Saway BF, Fielder T, Alshareef MA, Rafka HE, Sattur M, Lena J. Infratentorial retroclival and tentorial subdural hematoma from posterior communicating artery aneurysm rupture: A case report and systematic review of literature. Surg Neurol Int 2022; 13:499. [DOI: 10.25259/sni_758_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
The objective of this systematic review is to evaluate the pathogenesis, clinical course, and prognosis of patients who suffer from aneurysm rupture, leading to subdural hematoma (SDH) of the infratentorial space without associated subarachnoid hemorrhage (SAH).
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature review was conducted in PubMed and Scopus electronic databases for relevant published cases of aneurysmal SDH (AnSDH) of the infratentorial compartment without associated SAH. The presentation, treatment, clinical course, and outcome of identified cases are compiled. In addition, a patient suffering from an infratentorial SDH following aneurysm rupture is presented with an illustrative case.
Results:
Three articles were identified and met inclusion criteria. All cases occurred from ruptured posterior communicating artery aneurysms. All patients arrived with a Hunt and Hess classification of 2 or less. Only one case was managed with operative aneurysm clipping and hematoma evacuation while the other three cases were managed endovascularly. There were no reported postoperative complications, vasospasm, or seizures reported. All patients had a final Modified Rankin score of 3 or less at last reported follow-up.
Conclusion:
Infratentorial AnSDH without associated SAH is an etiology rarely reported in the literature. Here, we present a case report and systematic review demonstrating a relatively benign clinical course and outcome compared to report aneurysm rupture associated with SAH or mixed SAH and SDH. Moreover, there appear to be lower rates of vasospasm and improved outcomes in patients with isolated AnSDH compared to the literature aneurysmal SAH rates.
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Affiliation(s)
- Brian Fabian Saway
- Department of Neurosurgery, Medical University of South Carolina, Charleston, United States
| | - Tristan Fielder
- Department of Neurosurgery, University of Texas at San Antonio, San Antonio, Texas, United States
| | | | - Habib Emil Rafka
- College of Medicine, Medical University of South Carolina, Charleston, United States
| | - Mithun Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, United States
| | - Jonathan Lena
- Department of Neurosurgery, Medical University of South Carolina, Charleston, United States
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Spontaneous acute subdural haemorrhage with rupture of distal anterior cerebral artery aneurysm: A case report and review of literature. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kaur G, Dakay K, Sursal T, Pisapia J, Bowers C, Hanft S, Santarelli J, Muh C, Gandhi CD, Al-Mufti F. Acute subdural hematomas secondary to aneurysmal subarachnoid hemorrhage confer poor prognosis: a national perspective. J Neurointerv Surg 2020; 13:426-429. [PMID: 32769111 DOI: 10.1136/neurintsurg-2020-016470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Aneurysmal ruptures typically cause subarachnoid bleeding with intraparenchymal and intraventricular extension. However, rare instances of acute aneurysmal ruptures present with concomitant, non-traumatic subdural hemorrhage (SDH). We explored the incidence and difference in outcomes of SDH with aneurysmal subarachnoid hemorrhage (aSAH) as compared with aSAH alone. METHODS Retrospective cohort study from 2012 to 2015 from the National (Nationwide) Inpatient Sample (NIS) (20% stratified sample of all hospitals in the United States). NIS database (2012 to September 2015) queried to identify all patients presenting with aSAH. From this population, the patients with concomitant SDH were identified. RESULTS A total of 10 075 patients with both cerebral aneurysms and aSAH were included. Of these, 335 cases of concomitant SDH and aSAH were identified. There was no significant change in the rate of SDH in aSAH over time. SDH with aSAH patients had a mortality of 24% compared with 12% (p=0.003) in the SAH only group, and only 16% were discharged home vs 37% (p=0.003) in the SAH group. CONCLUSIONS There is a 3.5% incidence of acute SDH in patients presenting with non-traumatic aSAH. Patients with SDH and aSAH have nearly double the mortality, higher rate of discharge to nursing home and rehabilitation, and a significantly lower rate of discharge to home and return to routine functioning. This information is useful in counseling and prognostication of patients with concomitant SDH and aSAH.
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Affiliation(s)
- Gurmeen Kaur
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Katarina Dakay
- Neurosurgery, New York Medical College, Valhalla, New York, USA
| | - Tolga Sursal
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Jared Pisapia
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Christian Bowers
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Simon Hanft
- Neurosurgery, UMDNJ Robert Wood Johnson Medical School New Brunswick, New Brunswick, New Jersey, USA
| | - Justin Santarelli
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Carrie Muh
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Neurovascular Surgery, Westchester Medical Center, Valhalla, New York, USA
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